Celebrating Difference, Working Toward the Same Goals: Native American Mental Health Care

Ron Morton, a member of the NAMI Board of Directors, is a psychologist and director of recovery and resiliency at ValueOptions in Tennessee.

by Kim Puchir, NAMI Communications Coordinator

Is it possible to meaningfully discuss general “Native American mental health issues”?

If you hear a conversation among Indian* people, you’re going to hear a lot about spirituality and elders, or maybe praying to spirits for help with mental illness. With some symptoms that the dominant culture might see as hallucinations, we might ask if someone has a relationship with spirits on the other side. We have a language among ourselves related to mental illness that we all understand pretty well although the way each tribe views mental illness is going to vary a little.

The government’s method of treating us all as one homogenous group is a view that has evolved over hundreds of years. It’s just more expedient to deal with one group that sees things the same way than it is to deal with a number of different groups that may see things differently.

How do these two different views—the government’s perspective versus the tribal—interact in terms of mental health services?

There is a conflict between self-determination and receiving government assistance. Self-determination implies responsibility—it acknowledges that a group has a right to determine what happens to them, the services they receive and the programs that they participate in.

There’s never enough money to go around to address problems the way the Indian community would like to address them. Casinos only benefit about 5 percent of Native Americans. The other 95 percent are living in pretty abject poverty. There are Indian people freezing to death each year because they can’t afford the propane to heat their homes in the colder parts of country. It’s hard to buy good, healthy food on a reservation.

What are some of the ways Native American communities would like to address mental illness?

One of the most serious problems is adolescent suicide. The rate is four times higher for Native American youth than it is for the general population.

There are approaches we use in Indian country that would probably benefit non-Indian populations. Many youngsters are looking for roots, for a connection that gives them a sense of who they are identity-wise. When you don’t have something to fill that void it may be filled by something that is more negative. Maybe a youngster needs to know what it means for them to be Irish or Scottish of Italian, for example.

It’s not a matter of throwing money or meds at a problem or putting up a clinic. When we’re talking about health interventions or access to care or funding, all these things fit together when creating solutions, but most communities are using traditional methods of healing to deal with problems. These may include elders, sweat lodges, healing ceremonies or sand painting.

"There are approaches we use in Indian country that would probably benefit non-Indian populations."

The medicine wheel, pictured, is just one of the Native American wellness traditions that are instructive for everyone seeking to live a more balanced life. Download the wellness resource kit courtesy of Maria Trevizo and the Native Wellness Institute.

What would be a more culturally competent view of mental illness and mental health care that comes closer to what the majority of Native Americans would want?

Each tribe may see a given mental illness differently. How close the tribe is to an urban center influences how they see bipolar disorder, major depression and schizophrenia.

We have our share of substance abuse, but there’s more focus on that problem in Indian country. We’re seen as “drunk Indians.” That’s how people who don’t understand us will paint the picture of mental illness in Indian country.

Another stereotype is that Indians are preoccupied with hating people because of our history. We don’t have time for that, any more than anyone else does. That doesn’t mean the history doesn’t impact us. I know people in South Dakota who can tell me the names of all their relatives who died at Wounded Knee. Most Indian people are of the mind that we need to get on with our lives and learn from the past—don’t ignore it, but don’t get preoccupied by it.

Another thing we have to look at very closely is medication—to see if these treatments are as appropriate with Indian people as they are for non-Indian people. We know we’re genetically different but we don’t know the ways that the medication might affect us because of that genetic difference.

To me, cultural competence means being willing to understand the differences in people. I have seen that on a national level NAMI is embracing in a major way the concept of the differences between communities. When you have a very clear cultural boundary it’s imperative that the dominant group and the minority group get together and find ways to bridge that gap.

Have things gotten better?

They may have, but there tend to be eras in which the dominant culture is more friendly to Indians, so we’ll see if it’s a lasting change. More than understanding the differences between cultures, we need to celebrate them. The medical community is going to have to take a position that says they are willing to learn.

"When you have a very clear cultural boundary it’s imperative that the dominant group and the minority group get together and find ways to bridge that gap."

The positive changes we’ve seen in the last few decades have come from a recognition that standard approaches weren’t working for minority groups or different cultures. So I think that looking for approaches that do work is progress, but there’s still a need to recognize traditional modes of healing as being credible—that what a medicine man does for healing is just as valuable as what a psychiatrist does. I think the services that medicine people provide are very valuable in helping make breakthroughs with folks who don’t see any improvement.

Do you have experience with traditional healing methods yourself?

I’ve always known I was Indian but I grew up in an urban center, San Jose, Calif. I never really felt I fit in there and I didn’t really understand why. Through my own challenges with mental illness and substance abuse, I grew closer to my culture and the healing that it provided. I’ve participated in sacred ceremonies throughout the country.

"Folks need to understand that stereotypes they have about Indian people don’t really exist. I have feathers but I don’t wear them. It’s a part of my life but not necessarily the entirety of who I am."

As an Indian and as a veteran, taking responsibility for myself and people around me was very important. Indian people are supposed to help all people who are less fortunate than ourselves, which helped lead me to the mental health field. Up until a couple years ago I was involved with direct services. Now I help develop and administer recovery and resiliency programs in Tennessee.

What are some changes you’d like to see happen for Native Americans?

Number one, folks need to understand that stereotypes they have about Indian people don’t really exist. I have feathers but I don’t wear them. It’s a part of my life but not necessarily the entirety of who I am. Most people in our society are constantly surrounded by people who have Indian blood but they don’t know that because we don’t make it very obvious.

Secondly, in some parts of this country, it’s really still not a good idea to be Indian. In east Tennessee, people have learned to put being Indian away because of the Trail of Tears. In the 1830s, Indian people were removed and those that were left had to go underground. They stayed underground for a long time and they’re very reluctant even now to talk about being Indian. That may mean acknowledging that they are out there. Every urban community in this country there is a large population of Indian people that not aware of.

We need to create a welcoming environment for Indian people to be Indian.